Peritonitis: what it is, causes, types, and why it is dangerous

Peritonitis is inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most organs of the abdominal cavity. Inflammation occurs when bacteria or chemical irritants enter the abdominal cavity. Without treatment, the condition is life-threatening, so it is classified as an emergency.

Peritonitis: what it is

The peritoneum covers the kidneys, liver, and intestines. When it becomes infected, the organs beneath it are also damaged. The area of the peritoneum is comparable to the area of the skin, so suppuration spreads quickly and the body develops general intoxication.

Surgeons clarify the definition: abdominal abscesses are excluded from the general definition. The prognosis with delayed or inadequate treatment is very unfavorable.

Causes of peritonitis

The most common cause of bacterial peritonitis is perforation of a hollow organ of the gastrointestinal tract: gastric or intestinal contents and microflora enter the abdominal cavity. The opening occurs with rupture of the appendix, perforation of a gastric or duodenal ulcer, perforation of a diverticulum or tumor, or overdistension of the intestine due to obstruction.

Other routes: bile or pancreatic enzymes in pancreatitis, abdominal trauma, catheters in the abdominal cavity, sepsis. Free fluid in ascites can also become purulent.

The causative organisms are Escherichia coli, Bacteroides fragilis, and enterococci. In premature and severely ill newborns, the cause is sometimes necrotizing enterocolitis.

Types of peritonitis: acute, purulent, fecal

The Lopukhin and Savelyev classification takes into account the course (acute, chronic), infection (primary, secondary, tertiary), exudate (serous, fibrinous, purulent, hemorrhagic), and extent: local, widespread (2–5 regions), general (6 or more).

Purulent peritonitis is a form with pus formation; opportunistic flora is involved, sometimes several causative organisms.

The term "fecal peritonitis" is not distinguished in the given classifications. When the intestine perforates, intestinal contents enter the abdominal cavity.

How peritonitis manifests

The main signs: abdominal pain, very high temperature or a sensation of heat, cold, chills, rapid heartbeat, absence of urine or a noticeably smaller amount. Additionally, there may be loss of appetite, nausea, vomiting, and a distended abdomen.

• vomiting that does not bring relief;
• tension of the muscles of the anterior abdominal wall;
• sharp tenderness when pressing on the abdomen.

The symptom of false well-being: after perforation the pain is severe, then subsides because the peritoneal receptors adapt, and after one or two hours it returns with renewed intensity. During peritoneal dialysis, a warning sign is dialysate in the bag that is cloudier than usual or contains white flakes.

Call 103 or 112 if abdominal pain is sharp and worsening, the anterior abdominal wall is tense and sharply tender when pressed, the temperature is very high with chills, the pulse is rapid, there is no urine or very little, and signs of shock appear.

How peritonitis is diagnosed: examination, blood test, imaging

During the examination, the doctor records altered parameters: temperature, pulse and respiratory rate, blood pressure, tension and tenderness of the abdomen.

Laboratory tests: complete blood count, blood chemistry, including pancreatic enzymes, liver and kidney function markers, blood culture, and examination of peritoneal fluid with Gram staining and culture. Instrumental tests include radiography or computed tomography of the abdominal cavity.

Severity is assessed using the Mannheim Peritonitis Index: eight risk factors, each scored from 0 to 12, with a total from 0 to 47. A value above 26 points predicts the probability of a fatal outcome with a sensitivity of 84%, specificity of 79%, and accuracy of 81%.

Complications and life after peritonitis

Complications: abscess, intestinal gangrene requiring surgery, intra-abdominal adhesions as a cause of future intestinal obstruction, and septic shock. The outcome varies from full recovery to generalized infection and death. It depends on how much time passed from the first symptoms to the start of treatment and on the overall state of health.

Treatment is carried out in a hospital: antibiotics are usually administered intravenously, and if necessary surgery is performed to eliminate the source of infection.

This material is for reference: it describes signs and examinations but does not replace consultation with a doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer